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Lincoln Caylor, Partner Bennett Jones LLP 416-777-6121 March 9, 2011

Managing the Risk Related to the Rogue Employee Through Insurance Fraud Insurance and Fidelity Bonds. Lincoln Caylor, Partner Bennett Jones LLP 416-777-6121 March 9, 2011.

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Lincoln Caylor, Partner Bennett Jones LLP 416-777-6121 March 9, 2011

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  1. Managing the Risk Related to the Rogue Employee Through InsuranceFraud Insurance and Fidelity Bonds Lincoln Caylor, Partner Bennett Jones LLP 416-777-6121 March 9, 2011

  2. "For whom they insure it is sweet to them to take the monies; but when disaster comes, it is otherwise and each man draws his rump back and strives not to pay." - Francesco di Marco Datini, Florentine merchant writing to his wife in the 14th century, in Against the Gods: The Remarkable Story of Risk by Peter L. Bernstein pg. 95 quoting Lloyd's of London: An Illustrated History.

  3. OUTLINE • Coverage • Exclusions • Making a Claim • Conducting an Internal Investigation • Responding to Insurer's Investigation • Recovery

  4. COVERAGEEmployees Covered • Generally: • Natural persons engaged in service of the insured in the ordinary course of business • May not cover: • Contract workers, volunteers, temps • Officers, directors • Terminated employees • Terminated employees covered • 30 - 60 days or not at all post-termination

  5. COVERAGERequisite Intent • Does an employee have to intend to defraud? • No default position • Some policies are silent on intent • Others require "manifest intent" • Sometimes coverage extends even when employee cannot be specifically identified

  6. COVERAGEDefinition of Loss • Generally includes: • The monetary value of what has been taken • Can include: • Costs to establish quantity of loss • Lost interest • Costs of proceedings to recover assets

  7. COVERAGETemporal Coverage • Generally • losses occurring in a prior period where they are discovered in the current period • Coverage may require: • Uninterrupted coverage from loss to discovery • Coverage limit from time of loss • Loss carryover to current period • Loss under terms of previous coverage • Limitation on discovery period

  8. COVERAGETerritorial Coverage • Commercial area of operation • Potential for broader coverage

  9. COVERAGE Preserving Coverage • Have systems beyond inventory, profit or loss calculation in place to quickly detect and calculate fraud or loss • Regular checks and audits, limited access to cash, and redundancy mechanisms • Carefully plan investigation to identify and preserve evidence to substantiate the claim • Be cognizant of all deadlines and be sure to act within them

  10. EXCLUSIONSDefinition of Loss • Generally excludes • Losses caused by employees that Insured knows have previously been involved in fraud, theft, or dishonest act • Sometime s previous theft must have occurred at Insured's business • Sometimes minimum dollar value of previous theft ($25,000)

  11. EXCLUSIONSDefinition of Loss • Unique Exclusions (vary by policy) • Aggravated, exemplary or punitive damages owing • Legal fees and other costs to establish loss (varies greatly) • Costs of data repair • Loss sustained by theft from client of insured by employee of insured • Loss on an induced asset sale

  12. EXCLUSIONSEffect of Collusion Among Partners • Generally no coverage if fraud/theft in collusion with partner of insured • Definition of partner varies between policies • Member of a partnership • Officers of a corporation • Members of a joint venture

  13. MAKING A CLAIMNotice Requirements Upon Discovery • Generally on Insured: • specified time to report notice of loss upon discovery • Can be 60-90 days • Sometimes unspecified or "whenever practicable" • Sometimes Insured must report loss to police when loss results from violation of law (fraud, theft etc.)

  14. MAKING A CLAIMNotice Requirements Upon Discovery • Generally on the Insurer: • Obligation to follow notice with provision of proof of loss • Must be within 60 days by Insurance Act s. 135

  15. MAKING A CLAIMNotice Requirements Upon Discovery • Insured must submit sworn proof of claim • Timelines vary between 4 months - 6 months • Litigation cannot be started for 60 days following submission of proof (Insurance Act, s. 136)

  16. MAKING A CLAIMDiscovery and Proof of Loss • Discovery of loss • Audit or 'tip-off' • Other internal investigation • Determining quantum of loss • Undefined • Market price • Investigative specialist • Inventory computation

  17. CONDUCTING AN INTERNAL INVESTIGATION • Engage counsel early for benefit of solicitor-client privilege • Develop a plan • Who is involved, what evidence is available, how to preserve that evidence • Whether or not required by the insurance policy, consider contacting police

  18. CONDUCTING AN INTERNAL INVESTIGATION • Gathering Evidence • Start collecting internally available proof—email, hard drive • Collect internal evidence in possession of the employee—Anton Piller order

  19. RESPONDING TO INSURER'S INVESTIGATIONObligations of the Insured • Employee background checks (consider if this is something to do in advance) • Can be cross-examined on sworn proof of loss • Requirement to cooperate with investigation • Notify police authorities

  20. RESPONDING TO INSURER'S INVESTIGATION Benefits of Engaging Law Enforcement • Prosecution can act as deterrent to other employees, showing real consequences associated with theft and fraud • Employer may be able to obtain a restitution order in sentencing

  21. RECOVERYRecovery Payments • Generally funds recovered are paid to the Insurer less costs of recovery • Insured may be able to allocate recoveries to • Losses incurred in excess of their liability limit • Losses specifically excluded in the Fidelity Bond • The amount of the deductible

  22. CONCLUSIONS • Complex and varied coverage available • Coverage can be tailored to specific businesses • Expect rigorous adjusting process • Careful compliance required with all steps to successfully make a claim

  23. Questions?

  24. Thank you!

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